Video report by ITV News Sports Editor Steve Scott
Teenage girls who play football are almost twice as likely to get concussion compared to their boy counterparts, according to a study.
Professor Willie Stewart at the University of Glasgow reviewed three years of injury data for a population of around 40,000 female high-school footballers in the Michigan High School Athletic Association.
Working with researchers at the University of Pennsylvania and Michigan State University, he compared data for a similar number of male footballers and found risk of sports-related concussion among female footballers was almost double - 1.88 times higher.
The study also suggests teenage girls are less likely to be removed from play and take on average two days longer to recover from injury and return to play than boys do.
Male footballers were most often injured colliding with another player and were 1.5 times more likely to be removed from play on the day of injury.
According to the findings, females were most often injured from contact with equipment such as the ball or a goalpost.
Prof Stewart, senior author of the study, says the outcomes raise the question of whether sports should consider sex-specific approaches to both participation and concussion management.
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He said: "Given we know the importance of immediate removal from play for any athlete with suspected concussion, it is notable that 'if in doubt, sit them out' appears more likely to happen for boys than girls.
"This, together with the finding that mechanism of injury appears different between boys and girls, suggests that there might be value in sex-specific approaches to concussion education and management in this age group."
Former Crystal Palace captain Freya Holdaway quit the game after suffering three concussions.
She said: “I felt so much better within myself. I was sleeping better, I wasn’t constantly worrying.
“My ears stopped ringing and it was one of those things where I thought ‘how can I go back?’”
Campaigners have been very critical of the Professional Footballers’ Association (PFA) over a lack of action on the issue of concussion.
Ex-pro Chris Sutton, whose dad Mike - also a footballer - died with dementia, has previously said outgoing PFA chief executive Gordon Taylor has “blood on his hands” over the issue.
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Dawn Astle - daughter of West Brom legend Jeff Astle, who died with a brain defection associated with heading the ball - said she was "pleased" when it was announced in 2019 that he would be stepping down.
She said: "My dad died, there could be thousands of others out there like him. But the PFA, the union meant to support them, the union whose entire existence is about player welfare, for me, has completely failed in its duty to try and understand why."
Prof Stewart, has previously said football’s approach to concussion was a “shambles”.
Mr Taylor defended himself and the PFA at the Digital, Culture, Media and Sport Committee, pointing to the three-year review which he ordered in 2017.
But Ms Astle has been questioning why it took 16 years for Mr Taylor to order the review, given her dad died after suffering dementia in 2002.
At the accusation from committee chair Julian Knight that the PFA had been “asleep at the wheel”, Mr Taylor said: “We’ve never been asleep on it.”
He also hit back at accusations from Prof Stewart that the PFA's response had been a shambles, saying he "would not agree".
He added: "It’s a ridiculous thing to say. This is a serious subject that we are giving serious attention to.”
The review into concussion was funded by the Football Association and the Professional Footballers' Association, NHS Research Scotland, the Penn Injury Science Center and a Brain Injury Training Grant.
Dr Abigail Bretzin is another lead author of the study, a postdoctoral fellow and certified athletic trainer at the University of Pennsylvania.
She said: "This is the first study to look in this detail at sex-associated differences in concussion management and outcomes in teenage footballers.
"Our findings add to research showing that female athletes are at increased concussion risk compared to male athletes, and highlight the importance of sex-specific research in this field."